系统评价和荟萃分析治疗慢性静脉功能不全患者无功能穿通支的方法。
Systematic review and meta-analysis of management of incompetent perforators in patients with chronic venous insufficiency.
机构信息
Division of Vascular Surgery, Department of Surgery, Stanford University, Palo Alto, CA.
Division of Vascular Surgery, Department of Surgery, Stanford University, Palo Alto, CA.
出版信息
J Vasc Surg Venous Lymphat Disord. 2022 Jul;10(4):955-964.e5. doi: 10.1016/j.jvsv.2021.12.088. Epub 2022 Feb 22.
OBJECTIVE
Incompetent perforator veins (IPVs) contribute to venous pathology and are surgically treated based on hemodynamic measurements, size, and the CEAP (Clinical, Etiological, Anatomical, and Pathophysiological) classification. The objective of the present study was to systematically review and synthesize the current literature regarding the surgical management of IPVs, including open ligation, subfascial endoscopic perforator surgery (SEPS), endovascular laser ablation, ultrasound-guided sclerotherapy, and radiofrequency ablation.
METHODS
English-language literature reported before November 2021 was reviewed from the PubMed, EMBASE, and MEDLINE databases for primary studies reporting safety and efficacy outcomes in the surgical treatment of IPVs. Study quality and risk of bias were assessed using the Cochrane risk of bias tool for comparative studies and a modified version of the Newcastle-Ottawa scale for noncomparative studies. A random effects model was used to pool the effect sizes for efficacy outcomes of wound healing and freedom from wound recurrence.
RESULTS
A total of 81 studies were included for qualitative synthesis, representing 7010 patients, with a mean age of 54.7 years. The overall evidence quality was low to intermediate, with a moderate to high risk of bias in the comparative studies. An 11.3% complication rate was found across the interventions, with no reported incidence of stroke or air embolism. Regarding efficacy, the pooled estimates for short-term (≤1 year) wound healing were 99.9% for ultrasound-guided sclerotherapy (95% confidence interval [CI], 0.81%-1%), 72.2% for open ligation (95% CI, 0.04%-0.94%), and 96.0% for SEPS (95% CI, 0.79%-0.99%). For short-term freedom from wound recurrence, the pooled estimate for SEPS was 91.0% (95% CI, 0.3%-0.99%).
CONCLUSIONS
The current evidence regarding the treatment of IPVs is limited owing to the low adherence to reporting standards in the observational studies and the lack of randomization, blinding, and allocation concealment in the comparative studies. Additional comparative studies are needed to guide clinical decision-making regarding the invasive treatment options for IPVs.
目的
功能不全穿通静脉（IPV）是静脉病理的原因之一，其治疗方法基于血流动力学测量、大小以及临床、病因、解剖和病理生理（CEAP）分类。本研究旨在系统地回顾和综合目前关于 IPV 手术治疗的文献，包括开放式结扎、筋膜下内镜穿通静脉手术（SEPS）、血管内激光消融、超声引导下硬化治疗和射频消融。
方法
从 PubMed、EMBASE 和 MEDLINE 数据库中检索截至 2021 年 11 月之前发表的英文文献，以获取报告 IPV 手术治疗安全性和疗效的原始研究。使用 Cochrane 偏倚风险工具对比较研究和改良的 Newcastle-Ottawa 量表对非比较研究进行研究质量和偏倚风险评估。使用随机效应模型对伤口愈合和无伤口复发的疗效结果进行效应大小合并。
结果
共纳入 81 项研究进行定性综合分析，共纳入 7010 例患者，平均年龄为 54.7 岁。整体证据质量为低到中等，比较研究存在中等到高度偏倚风险。各项干预措施的并发症发生率为 11.3%，无报告的中风或空气栓塞发生率。关于疗效，短期（≤1 年）伤口愈合的汇总估计值为超声引导下硬化治疗为 99.9%（95%置信区间 [CI]，0.81%-1%），开放式结扎为 72.2%（95% CI，0.04%-0.94%），SEPS 为 96.0%（95% CI，0.79%-0.99%）。短期无伤口复发的汇总估计值为 SEPS 为 91.0%（95% CI，0.3%-0.99%）。
结论
由于观察性研究报告标准的低遵从性以及比较研究中缺乏随机化、盲法和分配隐藏，目前关于 IPV 治疗的证据有限。需要进一步的比较研究来指导 IPV 侵袭性治疗选择的临床决策。
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